Archive for the ‘future care’ Category

And the regulator adds companies are pulling out of contracts with councils as they are no longer ‘profitable.’ A national trend, it’s now happening across the West Midlands, but the real crunch will come in April when we see the next increment in the National Living Wage.

According to the Commission the crisis in social care funding means authorities can only afford to pay firms very low rates.

How long has West Midlands Care Association been warning this will happen? Err, years.

David Behan, chief executive of the CQC, was reported in the media as saying several major companies, including Care UK, had pulled out of local home care contracts.

Giving evidence to MPs at the Health Select Committee, he said firms were unable to ‘deliver the quality of care and the volumes of care at the price being offered’.

Association of Directors of Adult Social Services figures show that 57 per cent of councils have reported home care businesses giving up their contracts in the past six months.

The research estimates that this had involved 10,800 elderly and vulnerable residents.

Some 400,000 people in the UK receive council-funded home care.

Quote: “Mr Behan told MPs that companies were ‘leaving the market’ and replacements were ‘not coming in.’ The vast majority of contracts handed back in our experience have been domiciliary care contracts where providers are saying:

‘We can’t deliver the quality of care and the volumes of care at the price being offered.’

The news has drawn comment from Caroline Abrahams, Charity Director at Age UK, who says ‘It’s worrying to hear that some care providers are giving up trying to make existing contracts work as their costs rise but funding fails to keep pace, and if these organisations are losing confidence in the sustainability of the care sector how on earth are older people and their families supposed to put their trust in it?’

Significantly she adds: ‘No care provider would ever walk away unless they felt they had no choice and the fact some are now doing so says a lot about the parlous state of the market at present.’

Very true. Austerity measures have had a catastrophic effect on care and ultimately the economies of council-funded packages don’t stack up with the inevitable failure to release bed-blocking at hospitals.

Estimates suggest that the number of those aged 85 and over will have almost doubled by 2030.

I see the Select Committee chairs have sent a frank letter to Theresa May urging action to tackle the social care crisis. Their biggest fear, it appears, is that the Brexit circus will crowd out ‘domestic policy.’

Not a chance, I say.

There’s only one headline maker out there at the moment and that’s the Prime Minister’s new American ‘friend’, Donald Trump.

I can recall my seniors shouting at the television, offering running commentary on everything from the news and football referee decisions to the latest saga with long-departed Ena Sharples of Coronation Street.

This weekend I was almost doing the same as Trump seemed to fill every waking hour of newsfeed time. Of course, I’m not decrying that his game-changer on the world stage is not newsworthy, but . . . on home soil the critical nature of the social/NHS care latest seems to have fallen below the radar.

Mrs May must still be under a deal of pressure over the correspondence from three of the most influential Commons select committees urging her to seek a rapid cross-party consensus on the “immense challenge” of paying for health and social care in the future.

But the media frenzy has now a new focus and she must be secretly breathing a sigh of relief – albeit for a just a little while.

The letter – sent jointly by the Conservative MP Sarah Wollaston, of the health committee, Labour MP Meg Hillier, of the public accounts committee and Clive Betts, also a Labour MP, of the communities and local government committee, highlights fears that pressing issues at home are being put on the back burner.

“We are calling for a new political consensus to take this forward,” the letter reads (Guardian). “This needs to be done swiftly so that agreement can be reflected in the next spending round.”

The MPs maintain that any review should target both the health and social care systems, warning that separation of the two is “creating difficulties for individuals and avoidable barriers and inefficiencies”.

Not surprisingly, Mrs May was accused of failing to grasp the scale of the challenge, after the chancellor Philip Hammond ignored the care sector in his autumn statement last November.

And then of course, we had the announcement from Downing Street that local authorities would be able to increase taxers to sort out short-term needs. Bit of a knee-jerk response to associations like mine, I suspect.

The political consensus appears to put the blame for everything at the Brexit door. As the Guardian reported: “The intellectual energy will go into Brexit, the most ambitious civil servants will want to be in the Brexit departments; it will just be the focus of everything.”

The letter concludes: “In short, the problem is widely recognised – we now need political agreement so that a solution for the long term can be found. For our part we shall do what we can to contribute to a consensus. We look forward to hearing from you.”

Backing for the letter has come from The King’s Fund and the Local Government Association.

Taking a look back is always dangerous. Nostalgia of ‘better days’ and being transfixed with what has been is never good for moving on efficiently.

But we really can’t escape the fact the 2016 put up some of the bleakest headlines for care that I’ve ever seen.

Funding gaps in community services for older people, which could increase to £2.6bn by 2020; delays in discharging medically fit patients from hospital; regular breaches of safe hospital bed occupancy levels; and the government and the health and care sectors misaligned (what ever happened to the single budget for NHS and social care?).

It should have been the year that social care and healthcare finally start working together effectively . . . but we’re still waiting. There are, however, some green shoots of promise where the integration model has been pioneered.

As for funding for the future – the 6 per cent council tax rise announced in December is a start, but it diverts funds from housing and will leave some taxpayers out of pocket.

More significantly it will do little to solve the ageing population problem and overstretched care system.

Currently there’s a lot of behind the scenes talk of more joined-up care between the NHS and social and it’s this hope that keeps me motivated. Indeed, 2017 could be a year of promise (but only if you catch me on a good day).

Obviously, by melding the two streams of care – something that had never happened since the NHS was founded in 1948 – care can become the seamless experience our elderly population deserves.

Despite the protests over who is taking what out of combined budgets, there are already promising signs – local authorities should look to Greater Manchester which, in April 2016, became the first locality in England to merge its health and social care sectors and control its budgets.

In the west Midlands there have been snippets of joint funding news, but not always good as I hear of health always having the upper hand and snatching monies back into its pot.

Without change, social care as we know it will inevitably die and so will those for whom it cares. Reinventing budget mechanics can be achieved, I believe, and bring harmony between social and NHS care. Bring it on – the sooner the better.

Looking to be inspired for 2017 and needing that shot in the arm to pep you up for the months ahead? Take heart (or a pill) – here’s the news from the much respected Kings Fund: “2017 promises to be another challenging year for the health and care system, with demand for care increasing faster than the supply of resources.”

The January bulletin adds: “A system already stretched to its limits will have to work even harder to maintain current standards of care and to balance budgets.

“This requires a continuing focus on operational performance and renewed efforts to transform the delivery of care at a time when frontline staff are working under intense pressure.”

I’m already wilting, even though I know it’s true.

The Fund points out that the NHS five year forward view (Forward View) will be “tested to its limits as leaders work to improve performance and transform care.” And it adds: “The NHS locally has to deliver £15 billion of the £22 billion efficiency improvements required under the Forward View, with the remaining £7 billion to be delivered nationally. It also has to provide evidence that new care models are delivering benefits. Failure to do so will raise serious questions about the assumptions on which the Forward View was based and on the ability of leaders to deliver their plans.”

The popular think tank highlights five main priorities for 2017.

Here we go and I’m summarising . . .

Supporting new care models centred on the needs of patients

People should be much more involved in their own health and care and be offered the information and support to manage their medical conditions

More care should be delivered in people’s homes or closer to home

Much greater priority should be given to public health and prevention through partnerships between local government, the NHS and other organisations

Action by government is also needed to reverse the rising tide of obesity and other major risk factors.

Building on the Forward View – programmes of integrated care that are sustainable.

Sustainability and transformation plans (STPs) are a practical expression of care that offer the best opportunity for the NHS and its partners to work together to transform the delivery of care, but there’s a need to strengthen leadership as they move from planning to implementation.

Improving productivity and delivering better value

As an organisation with an annual budget of more than £100 billion, the NHS has plenty of scope to be more productive. Increasing productivity has become more urgent as funding increases have fallen and deficits among NHS providers have risen. Key issues include better value, involving patients more in decision-making and reducing unwarranted variations in care and to improve care

Developing and strengthening leadership at all levels

Improving care depends in large part on the quality of leadership throughout the NHS and the ability of leaders to engage and support staff to improve care. There is a need for compassionate and inclusive styles of leadership

The success of STPs and the new care models hinges on experienced organisational leaders developing into system leaders, who are able to work across boundaries to negotiate and implement improvements in care. There is a need for leaders ‘comfortable with chaos’ to make things happen

Securing adequate funding for health and social care

In April the NHS will enter the eighth year of unprecedented constraints on funding while adult social care is rapidly becoming little more than a threadbare safety net for the poorest and most needy older and disabled people. The prospects for the remainder of this parliament remain bleak, with limited scope for raising more funds for social care and the NHS having to plan for infinitesimal growth in 2018/19 and 2019/20.

The government must choose between finding additional resources for health and care or being honest with the public about the consequences of continuing austerity for patients and users of publicly funded social care. Finding additional resources means being willing either to increase taxation or to reallocate funds from other areas of spending. Being honest about the consequences of continuing austerity requires acknowledgement that current performance standards and new commitments like seven-day working cannot be delivered within available funding.

The more important challenge is to initiate a debate about a new settlement for health and social care, building on the work of the Barker Commission.

I genuinely wanted some rays of sunshine in this bleak report, but the skies are still dark. Here’s hoping things will get better and we’ll see more integrated approaches between the NHS and social care. . . it surely must be the way forward.

The other Saturday I watched the television news with a stunned sense of disbelief as the chief executive of the British Red Cross announced the NHS was in the middle of a “humanitarian crisis”.

I’d never thought of the Red Cross intervening in UK affairs in such a way – don’t the images of this worthy, brave orgaisation invade our news from far flung places where there’s famine and the ravages of conflict? Not any more it seems.

To hear its top man, Mike Adamson, explaining exactly what defines a humanitarian crisis and that it’s is now in England, stopped me in my tracks.

His definition was along the lines of . . .

“It affects many people over a prolonged period of time, something of threat to their health or wellbeing. Just think about the situation of someone, for example, waiting on a trolley in and A&E department for several hours, perhaps with no family around them after a fall, probably quite frightened. . . .”

The warning came as it emerged two patients died in the same A&E department within a week during “extremely busy” periods.

In December A&E department shut their doors 140 times and now cancer ops are being cancelled, I read in the newspapers.

Mr Adamson added extra cash was needed for health and social care to make the system sustainable.

What was that? Extra cash for social care. Indeed!

Sadly, at the root of the NHS crisis is a failing social care . . . and we have warned for years that it was terribly broken. They would not listen, and I’m not convinced they are listening now.

The official response from the NHS is predictable: What crisis? And this still remains the official line.

I find it odd that hospitals like Russells Hall, Dudley, is allegedly paying a company to try to help sort out their funding, either by pressurising care homes to drop their fees, or getting patients’ families to become fiscally involved. Surely this could never catch on after the government’s stalled attempt to get the public to invest in care insurance policies. The elephant in the room, of course, is a properly functioning social care system. Everyone knows it. The government, however, steadfastly refuses to acknowledge it.

Mr Adamson explained: “The British Red Cross is on the front line, responding to the humanitarian crisis in our hospital and ambulance services across the country.

“We have been called in to support the NHS and help get people home from hospital and free up much needed beds.” Called in by whom? I suspect the Department of Health.

Shadow health secretary Jonathan Ashworth said it was “staggering” that the Red Cross had been drafted in to help. I think so too, though I would add that his Government did precious little to grasp the nettle of social care during its term.

Of course, there’s much politicking to be had over this development in the care saga so we need to focus on facts.

Just about a year ago bed blocking was costing the NHS about £820 million per year.

Last summer the National Audit Office said delays in discharging patients from hospitals in England had risen by nearly a third over two years. Delayed transfers (bed blocking) have not improved and there’s a resigned approach that’s punching through that deeply disturbs me.

Across England, the audit office found that for every 100 beds, three days of use were taken by patients who no longer needed to be in hospital between March 2015 and February 2016.

Quite what 2017 analytics will deliver terrifies me, because it is in direct correlation to the ability of social care to unblock beds – something it can no longer do. And we all know the reasons why.

The question now is this: Exactly what will it take for the Government to intervene? Will it deliver the much-needed financial lifeline to social care, which could not only rescue struggling care providers, but also our hospitals and . . . dare I say, those people who need either one or both of those services,

Billions of pounds are needed to avoid the NHS and social care crisis – that’s the message which has been sent to Secretary of State for Health, Jeremy Hunt.

According to the Daily Mirror, leaders in the care sector have alerted Mr Hunt after three health areas revealed they face a combined shortfall of more than £2.4billion by the end of the decade

As we broke into November, the dire warning outlined that without extra money they will struggle to meet waiting time targets, provide enough hospital beds and basic levels of social care.

Sounds familiar, doesn’t it, and it’s right on our doorstep.

The Mirror reports: “The verdict is contained in the newly published Sustainability and Transformation Plans (STPs) for Birmingham and Solihull, North Central London and South West London.

Sustainability and Transformation Plans were ordered by NHS England boss Simon Stephens in December 2015 and charged 44 regions in England to come up with a five-year programme for providing health and social care in their areas.

I’m not a lover of red-top journalism, but this report is exactly what’s needed.

And it adds: “Of the three reports published so far Birmingham and Solihull warns it faces a £712million shortfall by 2020, South West London £828million and North Central London £876million.”

For the record, West Midlands Care Association is working very closely with Birmingham City Council and assessing the impact throughout the neighbouring Black Country region.

The shortfall will doubtless impact on areas already struggling like Sandwell, Walsall and Dudley.

Mark Rogers, the chief executive of Birmingham Council, says in the piece both health and social care face “huge challenges”. According to Mirror “this includes the need for at least 430 more hospital beds in the region.”

Personally, I’m struggling to find a creative way forward. All the cuts in social care have already been made and I fear the duty of care caveat is lost somewhere in the ether.

Budgets are not just shrinking, they are vanishing and the demand for care is astronomic.

Mr Hunt, I fear lives in a bubble as MP for South West Surrey, and as we all know the social care financial map is very different in his constituency.

There is a laudable push to get people out of hospital and back into their own homes with social care support. But it is catastrophically failing.

Let me quote the Mirror again: The North Central London STP says it is not “able to deliver universally for everyone to the standards we would like.

“Our analysis tells us that too many people stay longer in hospital than is medically necessary. There are challenges with meeting acute standards, as well as issues workforce sustainability.

“Some of our estates aren’t fit for purpose. Additionally, we face a financial challenge of £876million across health commissioners and providers by 20/21 if we do nothing,” the STP is reported as saying.

This could have been written of any number of LAs throughout the UK.

Chancellor Philip Hammond has a chance to help next week with his mini Budget on November 23.

In the light of bleak analysis, I truly hope he will understand his responsibilities towards care providers and those receiving care.

WE are working with Birmingham to look at the consequences for Domicilairy and Care Homes. The shortfall in Birmingham has impact on the Black Country with many people being placed in Sandwell Walsall and Dudley

Billions of pounds are needed to avoid the NHS and social care crisis – that’s the message which has been sent to Secretary of State for Health, Jeremy Hunt.

According to the Daily Mirror, leaders in the care sector have alerted Mr Hunt after three health areas revealed they face a combined shortfall of more than £2.4billion by the end of the decade

As we broke into November, the dire warning outlined that without extra money they will struggle to meet waiting time targets, provide enough hospital beds and basic levels of social care.

Sounds familiar, doesn’t it, and it’s right on our doorstep.

The Mirror reports: “The verdict is contained in the newly published Sustainability and Transformation Plans (STPs) for Birmingham and Solihull, North Central London and South West London.

Sustainability and Transformation Plans were ordered by NHS England boss Simon Stephens in December 2015 and charged 44 regions in England to come up with a five-year programme for providing health and social care in their areas.

I’m not a lover of red-top journalism, but this report is exactly what’s needed.

And it adds: “Of the three reports published so far Birmingham and Solihull warns it faces a £712million shortfall by 2020, South West London £828million and North Central London £876million.”

For the record, West Midlands Care Association is working very closely with Birmingham City Council and assessing the impact throughout the neighbouring Black Country region.

The shortfall will doubtless impact on areas already struggling like Sandwell, Walsall and Dudley.

Mark Rogers, the chief executive of Birmingham Council, says in the piece both health and social care face “huge challenges”. According to Mirror “this includes the need for at least 430 more hospital beds in the region.”

Personally, I’m struggling to find a creative way forward. All the cuts in social care have already been made and I fear the duty of care caveat is lost somewhere in the ether.

Budgets are not just shrinking, they are vanishing and the demand for care is astronomic.

Mr Hunt, I fear lives in a bubble as MP for South West Surrey, and as we all know the social care financial map is very different in his constituency.

There is a laudable push to get people out of hospital and back into their own homes with social care support. But it is catastrophically failing.

Let me quote the Mirror again: The North Central London STP says it is not “able to deliver universally for everyone to the standards we would like.

“Our analysis tells us that too many people stay longer in hospital than is medically necessary. There are challenges with meeting acute standards, as well as issues workforce sustainability.

“Some of our estates aren’t fit for purpose. Additionally, we face a financial challenge of £876million across health commissioners and providers by 20/21 if we do nothing,” the STP is reported as saying.

This could have been written of any number of LAs throughout the UK.

Chancellor Philip Hammond has a chance to help next week with his mini Budget on November 23.

In the light of bleak analysis, I truly hope he will understand his responsibilities towards care providers and those receiving care.

WE are working with Birmingham to look at the consequences for Domicilairy and Care Homes. The shortfall in Birmingham has impact on the Black Country with many people being placed in Sandwell Walsall and Dudley